Max was born in October 2008 at Georgetown University Hospital. After more than four months at GUH, Max moved to the HSC Pediatric Center in March 2009. He came home six months after he was born, in April 2009.

Tuesday, December 9, 2008

Evening update (Tuesday 12/9)

Note: No new head circumference tonight. The midnight measurement will be posted at tomorrow's update.

Max's intestines are working well enough that, unless otherwise noted, you should assume that he's producing the quantity and quality of poop expected of an infant. Max's diapers (and occasionally the entire inside of his isolette) are now routinely filled with the classic "runny and sunny" output of a baby fed exclusively on breastmilk. We'll only note any future darkening or constipation related to mucus, fortification of the milk and so on if we think that there's an incipient GI freakout. Let me spend one last moment on the infant poop. There's something about the innocent yellow and seedy output of a newborn that evokes for me the very early days of parenting Felix. Proust thought that smell was the sense most powerfully associated with memory. And infant poop is my madeleine.

After the mid-morning bonus update, Max was alert and aware. Carolyn said that when she left to go pump Max turned to the sound of her voice. Carolyn likes to hold him lengthwise in her lap and do arm and leg exercises with him. In the late morning and early afternoon, Max returned to snoozing deeply.

When I came to visit around 6:00 PM (I missed the diaper change by minutes--again!), Max was again alert and aware. It may have had something to do with the caffeine being added to his evening feed. The nurses promise that they'll shift the caffeine schedule to his 9:00 AM feed before they send Max home with us. Presumably the alternative is that they send us home with enough caffeine for Max and his parents.

The NICU team are upping the volume and speed of Max's feeds. He'll soon be getting 45 ccs over the course of 30 minutes. For comparison, pure gravity alone would drain that much into a healthy infant in about 15 or 20 minutes. This is important because, should he successfully start breast-feeding or bottle-feeding (as opposed to having milk pumped into his stomach), he'll need to get a full three hours of nutrition is 30 minutes or so. This leaves 30 minutes for burping, cleaning up, etc., 30 minutes for soothing, and 90 minutes for Mom and Dad to sleep before the cycle begins anew.

At the late night call, Nurse K reported that Max was slightly tachypnic, i.e. that he was breathing faster than normal. This is a sign of respiratory distress. Like all of Max's respiratory problems, I blame gastric problems. While I promised to quit talking about his feces, the boy (like his older brother at this age), is gassy as heck. Nurse K reported putting him on his stomach to ease his gas. Oh yes, good point: Add this to the list of NICU oddities: none of this "back to sleep" nonsense. The little astronauts barely have an opportunity to skip a couple of breaths before they're being assualted by a nurse armed with a damp cloth looking to stimulate them. What this will do to Max's longer-term development I choose not to consider.

Speaking of memories, this picture was taken when Felix was about six weeks old (about Max's age now). It will be weeks more before I get to rock Max, but he too will have his chance to stare blankly at his father's collection of Civil War memoirs.